| NPI | 1649357187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0523) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 550057-1) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-08-26 |